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Published on: July 13, 2019
The effect of multiple concurrent central venous catheters on central line-associated bloodstream infections
Cathleen Concannon1, Edwin van Wijngaarden, Vanessa Stevens
1Center for Community Health, University of Rochester Medical Center, Rochester, New York.
Insights
Having multiple central venous catheters (CVCs) significantly increases the risk of central line-associated bloodstream infections (CLABSI). This finding holds true even when accounting for patient comorbidities and disease severity, highlighting CVCs as an independent risk factor.
Area of Science:
- Infection Control
- Patient Safety
- Healthcare Epidemiology
Background:
- Current surveillance for central line-associated bloodstream infections (CLABSI) does not account for patients with multiple concurrent central venous catheters (CVCs).
- The presence of multiple CVCs may increase CLABSI risk by providing additional vascular access points.
- Differentiating the impact of multiple CVCs from patient comorbidities and disease severity on CLABSI risk is challenging.
Purpose of the Study:
- To investigate the independent impact of multiple CVCs on the risk of developing CLABSI.
- To determine if multiple CVCs remain a significant risk factor for CLABSI after adjusting for patient comorbidities and disease severity.
- To inform accurate CLABSI rate calculations and hospital comparisons.
Main Methods:
- A case-control study design was employed.
- Data were collected from 197 CLABSI cases and 201 controls with CVCs at a tertiary care academic medical center (2008-2010).
- Multivariable logistic regression analyzed the association between multiple CVCs and CLABSI, controlling for APACHE II and Charlson Comorbidity Index scores.
Main Results:
- Patients with multiple CVCs had a 4.2-fold increased risk of CLABSI compared to those with a single CVC.
- Multiple CVCs remained an independent risk factor for CLABSI (OR, 3.4) even after adjusting for disease severity and comorbidities.
- The findings indicate that multiple CVCs are a significant contributor to CLABSI risk.
Conclusions:
- Multiple CVCs are an independent risk factor for CLABSI, irrespective of illness severity.
- Accurate CLABSI surveillance and hospital benchmarking may require adjustments for the number of CVCs.
- This research underscores the importance of considering catheter burden in infection control strategies.
Objective:
The current central line-associated bloodstream infection (CLABSI) surveillance rate calculation does not account for multiple concurrent central venous catheters (CVCs). The presence of multiple CVCs creates more points of entry into the bloodstream, potentially increasing CLABSI risk. Multiple CVCs may be used in sicker patients, making it difficult to separate the relative contributions of multiple CVCs and comorbidities to CLABSI risk. We explored the relative impact of multiple CVCs, patient comorbidities, and disease severity on the risk of CLABSI.
Design:
Case-control study.
Setting:
A total of 197 case patients and 201 control subjects with a CVC inserted during hospitalization at a tertiary care academic medical center from January 1, 2008, to December 31, 2010.
Methods:
Multiple CVCs was the exposure of interest; the primary outcome was CLABSI. Multivariable logistic regression was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) describing the association between CLABSI and multiple CVCs with and without controlling for Acute Physiology and Chronic Health Evaluation (APACHE) II and Charlson comorbidity index (CCI) scores as measures of disease severity and patient comorbidities, respectively.
Results:
Patients with multiple CVCs (n = 78) showed a 4.2 (95% CI, 2.2-8.4) times greater risk of CLABSI compared with patients with 1 CVC after adjusting for CLABSI risk factors. When including APACHE II and CCI scores, multiple CVCs remained an independent risk factor for CLABSI (OR, 3.4 [95% CI, 1.7-6.9]).
Conclusions:
Multiple CVCs is an independent risk factor for CLABSI even after adjusting for severity of illness. Adjustment for this risk may be necessary to accurately compare rates between hospitals.
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